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Hesi rn 315 pharmacology exam
Total Questions : 60
Showing 10 questions, Sign in for moreA client with type 2 diabetes mellitus is managed with glimepiride. The primary healthcare provider (HCP) adds a new prescription for injectable exenatide. Which information is most important for the nurse to teach this client?
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
Patient Data
The nurse is discussing the client's pain management with a student nurse.
Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided.
Morphine is a
Explanation
- Pure opioid agonist: Morphine is classified as a pure opioid agonist because it fully binds and activates opioid receptors, particularly mu receptors, producing maximum analgesic effects for moderate to severe pain management.
- Mixed opioid antagonist: Mixed opioid antagonists, like nalbuphine, both activate and block opioid receptors depending on the site. Morphine does not block opioid activity; it purely stimulates, making this choice incorrect.
- Non-opioid analgesic: Non-opioid analgesics, such as acetaminophen and NSAIDs, relieve mild to moderate pain without acting on opioid receptors. Morphine’s mechanism and use are specific to the opioid class.
- Partial opioid agonist: Partial agonists, such as buprenorphine, activate opioid receptors but produce a weaker response compared to pure agonists. Morphine elicits a full receptor response, differentiating it from partial agonists.
- Mu: Mu receptors are the primary opioid receptors activated by morphine, leading to effects such as analgesia, euphoria, respiratory depression, and decreased gastrointestinal motility.
- Beta: Beta receptors are adrenergic receptors involved in cardiovascular responses, not pain modulation. Morphine does not interact with beta receptors.
- Alpha: Alpha receptors are also part of the adrenergic system and regulate vascular tone and blood pressure. Morphine’s action is not through alpha receptor activation.
- Severe pain: Morphine is most commonly used to treat moderate to severe acute or chronic pain, especially postoperative pain, cancer pain, and trauma-related injuries requiring strong opioid therapy.
- Hypertension: Morphine is not indicated for treating hypertension. While it may indirectly lower blood pressure due to vasodilation and reduced sympathetic tone, it is not a therapeutic antihypertensive agent.
- Depression: Morphine is not used for managing depression. Although it can induce feelings of euphoria, its clinical use is strictly for pain relief, not mood disorders.
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400
Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site.
1400
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring Morphine 1 mg/hour continuous IV infusion via patient controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
Patient Data
Which actions should the nurse take to assure safety during morphine administration? Select all that apply.
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400
Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site.
Vital signs
Heart rate 77 beats/minute
Respirations 16 breaths/minute
Blood pressure 118/74 mm Hg
Oxygen saturation 97% on room air
1400
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring
Morphine 1 mg/hour continuous IV infusion via patient-controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
Patient Data
Which other medications would the nurse expect the surgeon to prescribe along with morphine? Select all that apply.
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400
Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site.
- Heart rate 77 beats/minute
- Respirations 16 breaths/minute
- Blood pressure 118/74 mm Hg
- Oxygen saturation 97% on room air
1400
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring
Morphine 1 mg/hr continuous IV infusion via patient controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
1500
Docusate sodium 240 mg PO every morning
Naloxone 2 mg IV push PRN for respiratory depression
Ibuprofen 600 mg PO every 6 hours as needed (PRN)
Patient Data
The charge nurse places a fall precautions sign on the client's door. Which side effects of morphine could contribute to this client's fall risk? Select all that apply
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400
Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site.
- Heart rate 77 beats/minute
- Respirations 16 breaths/minute
- Blood pressure 118/74 mm Hg
- Oxygen saturation 97% on room air
1800
- Heart rate 79 beats/minute
- Respirations 14 breaths/minute
- Blood pressure 114/78 mm Hg
-
Oxygen saturation 93% on room air
1500
Responded to an alarm in the room. The client is not responsive. Respiratory rate is 5 breaths/minute. Heart rate is 92 beats/minute. Pupils are pinpoint. Oxygen saturation 54% on room air.
1400
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring
Morphine 1 mg/hour continuous IV infusion via patient-controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
1500
Docusate sodium 240 mg PO every morning
Naloxone 2 mg IV push PRN for respiratory depression
Ibuprofen 600 mg PO every 6 hours as needed (PRN)
Patient Data
Which should the nurse do immediately? Select all that apply.
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400
Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site.
- Heart rate 77 beats/minute
- Respirations 16 breaths/minute
- Blood pressure 118/74 mm Hg
- Oxygen saturation 97% on room air
1800
- Heart rate 79 beats/minute
- Respirations 14 breaths/minute
- Blood pressure 114/78 mm Hg
- Oxygen saturation 93% on room air
1900
Responded to an alarm in the room. The client is not responsive. Respiratory rate is 5 breaths/minute. Heart rate is 92 beats/minute. Pupils are pinpoint. Oxygen saturation 54% on room air.
1400:
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring
Morphine 1 mg/hour continuous IV infusion via patient-controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
1500:
Docusate sodium 240 mg PO every morning
Naloxone 2 mg IV push PRN for respiratory depression
Ibuprofen 600 mg PO every 6 hours as needed (PRN)
Pressed the rapid response call button and provided rescue breaths with a manual resuscitation bag. The charge nurse administered naloxone 2 mg IV push as prescribed.
Patient Data
For each statement, click to indicate whether the statements by the student nurse indicate understanding or no understanding of naloxone. Each row must have one option selected.
Explanation
Understanding:
- "You can give naloxone intravenously, intramuscularly, or subcutaneously."
- "If the first dose does not work, you can give as many doses as needed to reverse respiratory depression."
- "Naloxone works best on pure agonist opioids."
No Understanding:
- "Naloxone will not affect the client's level of pain."
- "When given IV, naloxone starts working immediately and can last several hours."
Rationale:
- "Naloxone will not affect the client's level of pain. This shows no understanding because naloxone blocks all opioid receptors, including those responsible for analgesia. Once naloxone is administered, the client's opioid-induced pain relief is lost, and pain will likely intensify unless managed separately.
- "You can give naloxone intravenously, intramuscularly, or subcutaneously." This shows understanding because naloxone is approved for IV, IM, and SC administration. IV is preferred for rapid effect in emergencies, while IM or SC may be used when IV access is delayed or unavailable.
- "When given IV, naloxone starts working immediately and can last several hours." This shows no understanding because naloxone’s onset is rapid when given IV (within 1–2 minutes), but its duration is short, generally lasting 30–90 minutes. It often requires repeated dosing to sustain reversal effects.
- "If the first dose does not work, you can give as many doses as needed to reverse respiratory depression." This shows understanding because multiple doses of naloxone may be necessary depending on the opioid’s half-life and the severity of respiratory depression. Repeated dosing ensures that ventilation is supported adequately.
- "Naloxone works best on pure agonist opioids." This shows understanding because naloxone is most effective against pure opioid agonists like morphine, heroin, and fentanyl. It competitively displaces these substances from opioid receptors, reversing their full agonist effects.
The nurse is caring for a client with type 2 diabetes mellitus who is taking liraglutide. Which problem(s) in the client's history may increase the risk for development of pancreatitis? Select all that apply.
The nurse is providing instructions about a client's new medications. How should the nurse explain the purpose of probenecid, a uricosuric drug?
Which action should the nurse take to assess for analgesic tolerance in a client who is unable to communicate?
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